Reumatol Clin. 2012;8(4):168–173 www. reumatologiaclinica.org Original article Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis Everardo Álvarez-Hernández a , Ingris Peláez-Ballestas a , Annelies Boonen b , Janitzia Vázquez-Mellado a,c , Adolfo Hernández-Gardu ˜ no d , Fernando Carlos Rivera e , Leobardo Teran-Estrada f , Lucio Ventura-Ríos g , César Ramos-Remus h , Cassandra Skinner-Taylor i , Maria Victoria Goycochea-Robles j , Ana Guislaine Bernard-Medina k , Rubén Burgos-Vargas a,c,∗ a Rheumatology Unit, Hospital General de México, Mexico City, Mexico b Rheumatology Department, Maastricht University Medical Centre, The Netherlands c Faculty of Medicine, Universidad Nacional Autonoma de México, México, Mexico d Department of Pediatrics, Hospital Universitario “José Eleuterio Gonzalez”, Monterrey, Nuevo León, Mexico e RAC Salud Consultores S.A. de C.V., México DF, Mexico f Hospital General de Zona 1, IMSS, Morelia, Michoacán, Mexico g Hospital Central Sur, PEMEX, México DF, Mexico h Centro Médico Nacional de Occidente IMSS, Jalisco, Mexico i Department of Rheumatology, Hospital Universitario “José Eleuterio Gonzalez”, Monterrey, Nuevo León, Mexico j Research Unit, Colegio Mexicano de Reumatología, México DF, Mexico k Hospital Civil, SS, Guadalajara, Jalisco, Mexico a r t i c l e i n f o Article history: Received 17 February 2012 Accepted 2 May 2012 Available online 15 June 2012 Keywords: Health care Health policy Rheumatoid arthritis Socioeconomic factors a b s t r a c t Background: The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. Objective: To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. Patients and methods: This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). Results: We included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care cover- age, respectively. RA annual cost was $ 4653.0 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catas- trophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87). Conclusion: The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with frag- mented health care systems. © 2012 Elsevier España, S.L. All rights reserved. Gastos catastróficos en salud y el empobrecimiento de los hogares de los pacientes con artritis reumatoide Palabras clave: Cuidado de la salud r e s u m e n Antecedentes: El costo de ciertas enfermedades puede dar lugar a gastos catastróficos y el empobrec- imiento de las familias sin apoyo financiero por los organismos del Estado y otros. ∗ Corresponding author. E-mail addresses: burgosv@prodigy.net, r.burgos.vargas@gmail.com (R. Burgos-Vargas). 1699-258X/$ – see front matter © 2012 Elsevier España, S.L. All rights reserved. http://dx.doi.org/10.1016/j.reuma.2012.05.002 Documento descargado de http://www.reumatologiaclinica.org el 02/08/2012. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.